- Reviews status of work queues and prioritizes job functions to ensure timely follow-up on patient accounts.
- Confirms all pre-bill edits have been cleared, and all required signatures have been obtained prior to billing.
- Assists in gathering documentation necessary to respond to the initial data requests and any subsequent appeals.
- Receives and answers inquiries from patients and insurance companies regarding charges and/or billing discrepancies.
- Tracks and reports the status of claims denied and in the appeal process, including both payments and adjustments.
- Promotes positive customer relations.
- Reviews Explanation of Benefits (EOB’s) and Remittance Advices (RA’s) and completes appropriate follow up which may include appealing full or partial denials, billing any unpaid balance to a secondary insurer, if one exists, or submitting the claim for the unpaid balance to the patient.
- Complies and submits for approval the supporting documentation for accounts to be granted a charity allowance or referred to an outside collection agency for further collection action.
- Assists with orientation and training of new employees/ volunteers, as assigned.
- Attends meetings and seminars with insurance plans, medical groups and IPA’s.
- Completes appropriate forms as requested by the department.
- Demonstrates expertise in all aspects of Insurance billing functions.
- Documents detailed notes including action items taken, when appropriate.
- Documents detailed notes to all incoming correspondence and inquiries from payers, patients and other departments.
- Elevates issues as appropriate to Manager..
- Identifies and resolves payer issues and patient billing complaints
- Follows up with appropriate personnel and insurance agencies, etc to advise and resolve problem issues, and inform Manager of outcome.
- Issues appropriate denial letter and mails within specified timeframe.
- Performs collection actions including contacting patient, insurance companies, or third party payers.
- Prepares and submits write off requests to Manager for denied claims that cannot be appealed.
- Responds timely and accurately to all incoming correspondence and inquiries from payers, patients and other departments.
- Reviews explanation of benefits to resolve accounts.
- Reviews claim scrubber and resolves claim edits..
- Accesses computer system(s) for retrieval of patient information.
- Reviews patient account with credit balances. Makes corrections, if needed and or submits refund request when appropriate.
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